Cerebral oximetry monitoring using near-infrared spectroscopy during adult procedural sedation: a preliminary study

Abstract

Background and objectivesWe sought to evaluate the effect of adult procedural sedation on cerebral oxygenation measured by near-infrared spectroscopy (rSo2 levels), and to assess whether respiratory depression occurring during procedural sedation was associated with decreases in cerebral oxygenation.MethodsWe performed a prospective, observational preliminary study on a convenience sample of adult patients (>18 years) undergoing unscheduled procedural sedation in the ED from August 2017 to September 2018 at Hennepin County Medical Center in Minneapolis, Minnesota. The primary outcome measures were rSo2 values by level of sedation achieved and the incidence of cerebral hypoxaemia during procedural sedation (absolute rSo2 ≤60 or decrease ≥20% from baseline). The secondary outcome is the decrease in rSo2 during episodes of respiratory adverse events (AEs), defined by respiratory depression requiring supportive airway measures.ResultsWe enrolled 100 patients (53% female). The median (IQR) rSo2 values (%) by each level of sedation achieved on the Observer Assessment of Alertness and Sedation (OAAS) scale 1–5, respectively, were 74 (69–79), 74 (70–79), 74 (69–79), 75 (69–80), 72 (68–76). The incidence of cerebral hypoxaemia at any point within the sedation (absolute rSo2 <60%) was 10/100 (10%); 2 out of 10 had rSo2 reduction more than 20% from baseline value; the median (IQR) observed minimum rSo2 in these patients was 58 (56–59). We observed respiratory depression in 65 patients via standard monitoring; of these, 39 (60%) required at least one supportive airway measure, meeting the definition of a respiratory AE. During these AEs, 15% (6/39) demonstrated cerebral hypoxaemia with a median (IQR) minimum rSo2 of 58 (57–59). Four patients (4%) had cerebral hypoxaemia without a respiratory AE.ConclusionCerebral oximetry may represent a useful tool for procedural sedation safety research to detect potential subclinical changes that may be associated with risk, but appears neither sensitive nor specific for routine use in clinical practice.

Perbandingan bupivacain 0,5% 15 mg dan fentanil 25 mcg dengna bupivacain 0,5% 15 mg terhadap nilai oksigenasi pada pasien dengan anestesi spinal

“…Selanjutnya berdasarkan nilai rSO2 pada penelitian ini di temukan adanya penurunan pada rSO2 pada T1 di kedua kelompok kemudian pada T2 di kelompok tanpa fentanyl di dapatkan nilai rSO2 yang mulai meningkat dan meningkat fentany pada T3, pada pasien yang mendapatkan anestesi spinal dengan bupivakain di tambah fentanyl di dapatkan penurunan nilai rSO2 pada T2 dan T3, hal ini juga sama di temukan dari penelitian Cegin et al pada tahun 2018 yang meneliti mengenai levobupivakain di tambah fentanyl di bandingkan dengan hanya levobupivakain dan di nilai nilai rSO-2 yang juga menemukan hal yang sama terdapat penurunan nilai rSO2, didapatkan penurunan nilai rSO2 ± 5 % pada kanan dan kiri hal ini dikarenakan efek dari fentanyl intratekal yang dapat menurunkan MAP dan CPP sehingga terjadi penurunan rSO2 (Carlson et al, 2021;Pellicer & Bravo, Aliran darah serebral sendiri dipengaruhi oleh dua faktor, yaitu tekanan perfusi serebral (Cerebral perfusion pressure) dan tahanan fentanyl serebral (Cerebral vascular resistance) (Kim et al, 2012;Lee et al, 2009). Nilai tekanan perfusi serebral didapati dari selisih nilai tekanan rerata arteri (Mean arterial pressure) dan tekanan fentanyl ial (Intracranial pressure).…”